Dental Fear In Children Research Articles

A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children

Dental anxiety is common in children. This study sought to determine the impact of viewing positive images of dentistry prior to a dental appointment on the anticipatory dental anxiety levels of children attending for dental treatment. Controlled trial. Assessment of anxiety and analysis of data were conducted blind to experimental condition. Assessment of anxiety was carried out in the waiting room postintervention but before the patient entered the dental surgery for treatment. Thirty-eight children and young adults attending a dental clinic in South West England. Participants were randomly assigned to one of two conditions. In both conditions the participant was asked to look at photographs for 2 min in the waiting area prior to their appointment. The intervention consisted of viewing positive images of dentistry and dental treatment, the control condition consisted of dentally neutral images. Positive and neutral images were validated independently by four paediatric dentists. The assessment of anticipatory dental anxiety was made blind to experimental condition and statistical analysis was conducted blind to group membership. Anticipatory anxiety assessed by the Venham Picture Test. A significant difference in anticipatory dental anxiety was found between the two groups (median-positive images = 0, median-neutral images = 3; P < 0.001). Anticipatory anxiety was not correlated to age (rho = 0.04 P > 0.05), there was no difference between male and female participants in their level of anticipatory anxiety (median-males = 0.5, median-females = 1 P > 0.05). Viewing positive images of dentistry and dentists results in short-term reductions in anticipatory anxiety in children.

Randomized pilot study to disseminate caries-control services in dentist offices.

BackgroundTo determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.).MethodsIn 1999, 53 dental offices in Washington Dental Service's capitation dental plan were invited to participate in the study, and consenting offices were randomized to intervention (n = 9) and control (n = 10) groups. Offices recruited 689 capitation children aged 6–14 and at risk for caries, who were followed for 2 years. Intervention offices received provider education and fee-for-service reimbursement for delivering fluoride varnish and sealants. Insurance records were used to calculate office service rates for fluoride, sealants, and restorations. Parents completed mail surveys after follow-up to measure their children's dental utilization, dental satisfaction, dental fear and oral health status. Regression models estimated differences in service rates between intervention and control offices, and compared survey measures between groups.ResultsNineteen offices (34%) consented to participate in the study. Fluoride and sealant rates were greater in the intervention offices than the control offices, but the differences were not statistically significant. Restoration rates were lower in the intervention offices than the control offices. Parents in the intervention group reported their children had less dental fear than control group parents.ConclusionDue to low dentist participation the study lacked power to detect an intervention effect on dentists' delivery of caries-control services. The intervention may have reduced children's dental fear.

Dental fear in children may be related to previous pain experience during dental treatment

Versloot J, Veerkamp JS, Hoogstraten J, Martens LC. Children's coping with pain during dental care. Community Dent Oral Epidemiol 2004;32(6):456-61. 2b The purposes of the study were 3-fold: 1. To investigate the coping strategies that 11-year-old children use when they are in pain at the dentist and how they judge their effectiveness. 2. To study the extent to which the level of children's dental fear and their experience with pain at the dentist relates to their ability to cope and their choice of coping strategies. 3. To analyze the possible differences between subsamples of children with different levels of dental caries, expressed by decayed, missing because of caries, filled, surface (DMFS) index. Information not available. Cohort study

Effect of psychological management techniques on specific item score change during the management of dental fear in children

The aim of the study is to determine how specific fear inducing items contribute to the overall dental fear level in Nigerian children. In addition, it looks at the specific changes that psychological management produces on each item and how variables like age, gender and type of treatment received contribute to these specific changes observed. The dental fear level of 75 children, who were attending the dental clinic for the first time were assessed pre and post-treatment using the short form of the dental subscale of the child fear survey schedule. During treatment, the children were managed using various forms of psychological management strategies. The effect of age and the gender of the children on the dental fear level were analyzed. The effect of the type of treatment received, categorized into either invasive or non-invasive, on the dental fear level was also determined. Results showed that with the use of psychological management strategies, dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009). However, no statistically significant dijfference was noted in the dental fear scores based on age, gender and type of treatment received. On the other hand, the aggregate scores for each of the possible fear inducing items highlighted in the psychometric scale varied and so did the effectiveness of psychological techniques in significantly reducing dental fear scores for each of the items. Age, gender and type of treatment did have significant effect on the fear level changes that occur with specific items. It was concluded that although a significant change occurred in the dental fear level score of the child post management with psychological techniques, this does not necessarily translate to significant changes in the scores for each fear inducing item assessed by the psychometric scale. Age, gender and the type of treatment the child received also influence the change that could occur for each item. The dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009).

Dental fear of Finnish children in the light of different measures of dental fear

Objectives. The aims were: (1) to examine the construct and reliability of the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) among children of different ages and (2) to compare the correlations between fear measured with the modified CFSS-DS, the “peak value for dental fear” (PV), and “fear of dental treatment in general” (GF). Methods. The study sample consisted of 302, 299, 314, and 297 children aged 6, 9, 12, and 15 years, respectively. Each child received a questionnaire to be filled out at home. An explorative factor analysis with varimax rotation was performed for eight items taken from the CFSS-DS and questions on fear of pain and suction used in the mouth. For further age-specific analyses, mean values were calculated for the sum of items that loaded >0.5 on each factor. The correlations between these values and PV and GF were studied. Results. The questionnaire was reliable. Two factors were revealed for each age: “treatment of dental decay” (TDD), which included fears related to invasive treatment, and “attending the dentist” (AD), which included fears related to dental visits in general. TDD explained over 50% of the variance, except among 9-year-olds. TDD mean values were higher among older children than among younger ones and correlated more strongly with PV than with GF. AD mean values were higher among younger children than among older ones and correlated more strongly with GF than with PV. Conclusion. The factor structures were fairly similar but the correlations between fear measures differed among children of different ages.

Children's coping with pain during dental care

The purpose of this study was (i) to assess the coping strategies of 11-year-old children when dealing with pain at the dentist, (ii) to determine the extent to which the level of the children's dental fear and their experience with pain at the dentist are related to their ability to cope and their choice of strategies, and (iii) to analyse the possible differences between subsamples concerning dental caries. The coping strategies were investigated using the Dental Cope Questionnaire (n = 597); the level of dental fear was assessed using the Children's Fear Survey Schedule (CFSS-DS); a question is asked whether a child had experienced pain at the dentist in the past and dental caries was assessed using the DMFS index. The results show that 11-year olds use a variety of coping strategies. Internal strategies are used most frequently, external coping strategies are used less frequently, and destructive strategies are hardly used. The subjects rate internal and external strategies as effective. Children with pain experience and fearful children use more coping strategies, with fearful children using more internal strategies. Reported pain and anxiety were related to the dental status. The use and choice of coping strategies seems to be at least partly determined by the level of dental fear and the child's experience with pain.

A critical appraisal of the use of tools for assessing dental fear in children

Objective: The aim of this article is to review and evaluate the uses of the various tools for assessing dental fear in the child. Method: A search and review of publications related to the various identified tools used for assessing dental anxiety in children was done. Attention was paid to the empirical findings with the main focus being the function for which the instruments were designed. The features as an ideal instrument for use in the measurement of dental fear in the child were examined. Results: The findings indicate that most of the existing tools can be appropriately used for epidemiological studies as well as for diagnostic purposes with some limitations. However, none of the existing tools are appropriately designed for determining treatment needs as well as for assessing treatment outcomes. Conclusion: It was concluded that there is a need to develop culturally sensitive instruments which would enhance the objective assessment of treatment need and treatment outcomes of dental fear in children. Key Words: Dental; Fear; Children; Appraisal; Measures African Journal of Oral Health Vol.1(1) 2004: 54-63

Factor Analysis of Children's Dental Fear -Relationship Between the Noise of the Dental Drill and Dental Fear-

Factor Analysis of Children's Dental Fear -Relationship Between the Noise of the Dental Drill and Dental Fear-

Dental fear and oral health and family characteristics of Finnish children

Objectives: Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. Methods: The subject groups were aged 3, 6, 9, 12, and 15 years in two middle‐sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. Results: Dental fear was higher among 12‐ and 15‐year‐old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12‐year‐olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six‐ and 12‐year‐olds who had experienced caries were more likely to report dental fear than were caries‐free children. Among 6‐year‐olds, father's education modified the effect of a child's caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. Conclusions: Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.

Treatment outcome in subgroups of uncooperative child dental patients: an exploratory study.

The principal aims of this study were to evaluate the treatment outcome in subgroups of uncooperative child dental patients and to test the validity of these subgroups, which were based on fear and personality characteristics. An exploratory, intervention study using quantified questionnaire, interview and observation data. Eighty-six 4 to 12-year-old uncooperative child dental patients (of whom 81 were divided retrospectively into four subgroups) and their accompanying parents were followed up during treatment at a specialist paediatric dental clinic in Sweden. Treatment was based on behaviour management techniques, supported by nitrous oxide/oxygen sedation if necessary. At baseline, parents answered a questionnaire including questions on child dental and general fear, temperament and behaviour, and parental dental fear, emotional stress, locus of control, parenting efficacy and attitudes to dental care, some of which were repeated post-treatment. The treating dentist rated child behaviour according to the acceptance of a maximum of 14 treatment steps at each visit. Approximately 90% of all children managed to undergo the dental treatment. Child dental fear and parental emotional stress decreased during treatment. Externalizing, impulsive children showed lower acceptance. In fearful, inhibited children, integrated use of sedation appeared to facilitate acceptance. Validity of the subgroups characterized as 'fearful, extrovert, outgoing', 'fearful, inhibited' and 'externalizing, impulsive' was supported, while heterogeneity within the group of 'non-fearful, extrovert, outgoing' children made validation difficult. Fear and personality characteristics may serve as diagnostic aids when planning treatment of uncooperative child dental patients. Controlled outcome studies using differentiated treatment methods for children with different fear and personality profiles are needed.

Childhood dental fear in relation to parental child-rearing attitudes.

The aim of this study was to assess the relation between parental self-reported child-rearing attitudes and dental fear in children. The parents of 51 children with high dental fear and of 56 children with low dental fear, of different age groups, completed the Amsterdam version of the Parental Attitude Research Instrument. In addition, parents were asked to rate their own dental fear. Multivariate analysis of variance (child fear x parental fear x child age) showed a significant main effect only of child dental fear on parental self-complaints (p = .03). For parental dental fear, main effects were found on overprotection and on promotion of autonomy (p < or = .01). No age effects were found. Also, no relation between children's dental fear and parental dental fear was found. Based on the present findings, it was concluded that parents may play a more secondary, mediating role in the etiological process of dental fear in children.

The etiology of childhood dental fear: the role of dental and conditioning experiences

This study was aimed to examine the relative importance of invasive treatment experiences in the acquisition of dental fear in children. For this purpose, the complete dental history of 401 children (5–10 years) was studied. The level of dental fear in these children was assessed using the Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS). Differences in treatment variables between fearful and low fearful children were analyzed, and regression analysis was performed to determine significant predictors of dental fear. A significant but weak relation with the number of extractions was found, while no relation with the number of fillings was found. The results have indicated that within the (direct) conditioning pathway, objective dental experiences seem to play a minor role in children’s fear acquisition, and it was suggested that subjective dental experiences may play a more decisive role. In addition, clinical support for the latent inhibition theory was provided.

The dental subscale of the children's fear survey schedule: predictive value and clinical usefulness

This study reports on the predictive value and clinical usefulness of the Dutch parental version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Parents of 718 children (4–12 years) completed this CFSS-DS version before or during the child's visit. The dentist rated the child's dental fear during treatment on a 5-point Likert-type Scale from 1 (not afraid at all) to 5 (very afraid). Reliability analysis was performed, and correlation coefficients between the two measures were calculated. The reliability of the scale proved to be high (Cronbach's α = .93) and significant correlation coefficients were found (r = .58 and r = .68, p < .01). The negative predictive value of the CFSS-DS was high (.96), whereas its positive predictive value was relatively low (0.41). It was concluded that the CFSS-DS might be of clinical value as a screening device of dental fear, whereas its predictive value of fearful behavior should not be overestimated.

Dental Fear in Children – a proposed model

Dental Fear in Children – a proposed model

A clinical study of child dental anxiety

Dental fear in children was studied using Rachman's theory of fear acquisition. Sixty children from two age groups (7–10 years, 11–14 years) participated in the project. The children were new patients attending a paediatric consultation clinic for specialised dental treatment. Thirty-one were diagnosed as being clinically anxious regarding dentistry and 29 were found to be nonanxious. Information regarding children's past experiences and present level of anxiety was obtained from the examining dentist, the children and their parents. Mothers were also interviewed and observed to ascertain their own anxieties and behaviour. The results showed that of Rachman's three pathways to fear, conditioning appeared largely responsible for the children's development of dental fear. Children's fear was more strongly associated with subjective experience of pain and trauma than with objective dental pathology. Indirect learning processes were found to be of only minor importance in this study.

Dental fear in children--a proposed model.

Over the past eleven years, we have worked together to treat children who are dentally phobic. This has enabled us to develop an understanding of how children come to be dentally fearful. We have constructed a model of child dental fear which helps us in our work. It is important to acknowledge that fear is a normal phenomenon when any of us are exposed to threat. Helping dentally fearful children appraise or evaluate threat, face their fear and build upon their strengths is the task facing dentists and, occasionally, psychologists. The consequences for children of not doing so are extreme difficulty with accepting and ultimately total avoidance of treatment. Both of these can persist into adulthood. First, we propose to discuss the normality of fear in children, placing dental fear within a developmental context. We will then outline a model for assessing and treating dental fear which identifies five discrete but interrelated factors. Each of the factors and its treatment is illustrated with examples.

The Dental Subscale of the Childrens Fear Survey Schedule: a factor analytic study in the Netherlands

The Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) is a well-known instrument for assessing dental fear in children. Previous studies have shown that the scale has acceptable reliability and validity. Factor analysis using scores of a group of Finnish schoolchildren resulted in three factors. No other data on the factor structure have been published. In order to report on the factor structure of the Dutch parental version of the CFSS-DS, the present study was undertaken. Factor analysis using scores from a group of Dutch children (n= 150) demonstrated a factor pattern fairly similar to the results found in the Finnish study. Three factors were found: 1) fear of highly invasive dental procedures, 2) fear of less invasive aspects of treatment and 3) fear of medical aspects. Considering that almost all items load substantially (> or =0.20) on more than one factor, it seems that one primary underlying dimension exists: fear of invasive treatment aspects. The CFSS-DS is proposed as a reliable, one-dimensional measure of dental fear.

Assessing child dental anxiety: the validity of clinical observations.

For children there are few validated psychometric measures of dental anxiety. The study reported here aims to examine the validity of using clinical observations as a measure of child dental fear. 100 children consecutively attending a community clinic were asked to complete the validated Child Fear Survey Schedule (CFSS). After the dental examination both dental nurse and dentist separately assessed the subject's dental fear using a checklist based on the CFSS schedule. High agreement was found between the child, the dentist and dental nurse respectively and principal components analysis suggested that a dual nature of anticipatory dental anxiety existed in children. The findings of this work suggest that clinical observations may be a valid means of assessing child dental anxiety status.

Procedures for reducing dental fear in children with autism.

Children with autism are often unable to tolerate dental examinations because of fear associated with sights and sounds in the dental operatory. This study applies procedures commonly used to reduce phobic behavior in otherwise normal persons and individuals with mental retardation, to dental fear in children with autism. Three male subjects were desensitized to a dental exam by the experimenter who paired the anxiety-causing event with stronger stimuli that elicited anxiety-antagonistic responses. Application of the treatment package resulted in successful completion of the steps in a dental exam in an analog setting, and a clinically significant increase in the number of steps completed in vivo. This study demonstrates that children with autism can be trained to cooperate during a dental exam.

Appraisal of behavioral measurement techniques for assessing dental anxiety and fear in children: A review

The aim of this article is to review and evaluate behavioral and physiological measurement techniques frequently used to assess dental anxiety and fear in children. Attention is given to the data collected, the empirical findings obtained, and the availability of normative data. The main focus, however, is on the reliability and validity. Results show that all questionnaires are open to criticism. Of the behavioral measures, Melamed's Behavior Profile Rating Scale is to be preferred to Frankl's Rating Scale, Venham Rating Scales, and Visual Analogue Scales. The main reasons are that Melamed's BPRS measures the behavior of the child more precisely and that it has superior psychometric properties. Furthermore, because of their practical, conceptual, and psychometric problems, physiological measures at this stage are found to be less appropriate for assessing dental fear in children. It is concluded that a behavioral measure is not always the ideal, but often the only available technique for assessing dental fear in children.